Research Update: Meniscus surgery

The study was reported in the New England Journal of Medicine and included 146 patients with persistent knee symptoms consistent with a meniscus tear, a proven meniscus tear on MRI and no significant arthritis, who were randomised to either "sham surgery" or surgery to remove the torn parts of the meniscus (usual practice).

Summary Below:

Partial meniscectomy NOT superior to sham surgery.

1. Patients who underwent arthroscopic partial meniscectomy did not have significant improvement in outcomes when compared to those who underwent a sham surgery.

2. There was no significant difference between groups in the number of patients requiring subsequent knee surgery or in the occurrence of serious adverse events.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Meniscal tears are a common knee injury and are often treated with arthroscopic medial meniscectomy. Although it is frequently performed, there is limited evidence from clinical trials to support the efficacy of this procedure. This multicentre, randomized, controlled trial including patients with degenerative medial meniscus tears found no significant difference in outcomes between arthroscopic partial meniscectomy and a sham surgical procedure. This suggests that patients may be undergoing unnecessary treatment and incurring excess cost to the health care system. The strength of this study lies in the design, which included blinding of patients, data collectors, and data analyzers, facilitated by the use of a sham surgery. It has been suggested that patients undergoing arthroscopic partial meniscectomy may be at a higher risk of developing osteoarthritis. Untreated tears are also at risk of developing into osteoarthritis. Prolonged follow-up will be required in order to assess these long-term outcomes.

Conclusion:

If you have several months of knee pain that is consistent with a medial meniscus tear, and if you have a meniscus tear on MRI, your symptoms are likely to improve with appropriate conservative treatment (exercise based physiotherapy). Having the torn parts of the meniscus removed will not change that in any meaningful way.